Hawaii Filipino Chronicle Supplement - September 17, 2022

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SEPTEMBER 17, 2022

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Monkeypox: The Latest Global and Community Health Threat WHAT’S INSIDE

HEALTHLINE: Get a Boost Against COVID: What You Need to Know About BoostersS2 HEALTH NEWS: Free Preparation Guidance for Medicare Open EnrollmentS2 HEALTH NEWS: September is National Suicide Prevention MonthS3 ASK A DOCTOR: Beyond Borders: MonkeypoxS6 ASK A DOCTOR: Out of the Fire, Into the Frying Pan: Long CovidS8 MENTAL HEALTH: The Impact of COVID on Mental Health and Helpful Coping TechniquesS10 MEDICAL REFLECTIONS: Confessions of a Surgeon New MomS11 ASK A DENTIST: Teeth SensitivityS14 HEALTHLINE RESEARCH: UH Reveals Vaccine Hesitancy Factors in Recent StudyS15


till recovering from the height of COVID-19, communities around the world are faced with yet another global viral outbreak, this time in the monkeypox. In less than a dozen times ever, the World Health Organization (WHO) declared monkeypox a public health emergency of international concern (PHEIC) on July 23, 2022. The first major cluster of monkeypox cases (outside of Africa, its origin) was found in the United Kingdom in May 2022. It has since spread to the U.S. in alarming numbers, even to our very own state where already 28 cases have been reported. For our cover story in this supplement, find out how to identify the symptoms of monkeypox, who should get the available vaccination at this time, and how to better protect yourself from catching it. In a concurring public health concern, the cover story also gives us an update on COVID-19 in Hawaii and the new bivalent vaccine recently made available. Stay informed and stay healthy!

Cover Story on S4




Get a Boost Against COVID: What You Need to Know About Boosters


OVID vaccines and boosters have reduced the threat of COVID, allowing many people to gather, travel, and celebrate with more peace of mind. Vaccines and boosters provide the best protection against the worst outcomes of COVID, yet people still have many questions around boosters. As of August 10, CDC data showed that while Asian Americans were among the highest boosted group—with nearly 70% of those eligible having received their first booster doses—only 14% of fully vaccinated Asian Americans 50 years or older have gotten their second booster. First booster rates are still low for Native Hawaiians and Pacific Islanders, with less than half of the population age 5 and older receiving their first booster doses. To that end, the We Can Do This COVID-19 Pub-

lic Education Campaign has engaged community-based organizations as partners to increase vaccine and booster uptake across the country. A partnership between Pacific Island Ethnic Art Museum (PIEAM) and Empowering Pacific Islander Communities (EPIC) has humanized the numbers behind those lost to COVID-19 with a curated community exhibit titled, Toe Fo’i: The Return. Through the power of storytelling from 6 Pasifika artists, Toe Fo’i: The Return evokes a narrative that “reminds visitors the stories of those lost are the stories of those who survived,” says Kiki Rivera, PIEAM Guest Curator and EPIC Storyteller. “COVID-19 devasted our Native Hawaiians and Pacific Islanders,” says Rivera, “We are as dedicated to drawing awareness to the importance of vaccines and boosters as we are to guiding our commu-

nities through the hurdles of misinformation, fear, mistrust, and entitlement that surround the topic.” Here is what people should know about the COVID boosters: Boosters provide the best protection against severe illness and death. Over time, vaccines may become less effective at preventing COVID, and just because you’ve had COVID doesn’t mean you can’t get it again. Getting boosted extends your protection and keeps you safer from emerging variants. A booster shot is another dose that — as the name suggests — boosts immunity to the virus as time passes. Vaccinated people who have also had a booster are less likely to get sick; but if they do catch the virus, the illness is usually less severe. For adults ages 65 or older, boosters can more than double their protection.

Vaccines and boosters protect vulnerable populations against COVID. Everyone 5 or older who has completed their initial COVID vaccination series should get a booster. Individuals who are up to date on COVID vaccines not only receive protection for themselves, but they also help reduce the spread of COVID to people who are at high risk due to age or compromised immune systems. Second boosters provide added protection for people at higher risk. Adults age 50 or older and immunocompromised individuals can improve their protection even more with a second booster. CDC recommends second boosters, with either the Pfizer or Moderna vaccines, for: • People age 50 or older who got their first booster four months or more ago • People who got a Johnson & Johnson vaccine and

• •

their first booster with a Johnson & Johnson dose at least four months ago Residents of long-term care settings People with certain underlying medical conditions that impact their immune systems Pregnant and recently pregnant people

Boosters are readily available to all vaccinated people ages 5 years or older. Just like the vaccines, booster shots are available at no cost to anyone living in the U.S. People who got Pfizer or Moderna vaccines should get a booster five months after the initial doses. Vaccinated adults 18 or older may choose any available vaccine as a booster, regardless of the type or brand of vaccine received previously. Only the Pfizer vaccine is available as a booster for those ages 5 to 17. For more information and to find a vaccine, visit www. vaccines.gov.


DOH Encouraging Navy Water System Users to Participate in Follow-Up Health Impact Survey


esidents who are using the Navy water system can now share their experiences with the State Health Department to further explore the impact of the jet fuel contamination in the US Navy’s Joint Base Pearl Harbor-Hickam drinking water system. The follow-up survey will support the initial survey conducted in January and February of this year. The survey will evaluate the ongoing public health impacts, water usage and attitudes toward the water system. The survey is being conducted by the Hawaii State Department of Health (DOH) and the Centers for Disease Control and Prevention’s Agency for Toxic Substances and Disease Registry. “Jet fuel contamination of a drinking water system on this scale is unprecedented,” said DOH State Toxicologist Dr. Diana Felton. “This follow-up assessment will further the understand-

ing of how the contamination impacted the health of impacted individuals and inform our public health response.” Individuals who were served by the Navy water system between November 20, 2021 and March 18, 2022 can access the online survey by heading to https://epiinfosecurewebsurvey.cdc. gov/Home/ed35dc5c-389b-4e06-934cdb7b8418ec36. The online survey will be open through Sept. 23, 2022. Participation is voluntary and identities will be kept confidential. The initial survey conducted in January and February surveyed over 2,200 participants. The Assessment of Chemical Exposure health impact survey found that 87% of respondents reported at least one new or worsening health symptom related to the contaminated water. Eighty percent reported improvement when they switched to an alternate water source. Moreover, 46% reported new mental health symptoms.




September is National Suicide Prevention Month


o raise awareness this National Suicide Prevention Month, the Hawaii Department of Health and the Prevent Suicide Hawaii Task Force are promoting available mental health resources and events. “National Suicide Prevention Month is an opportunity for the community to come together to raise awareness of this issue,” said Dr. Alvin Bronstein, Emergency Medical Services and Injury Prevention Systems Branch Chief. “Suicide prevention requires outreach and stakeholder collaboration to ensure resources and support are available to those most in need.” From 2017 to 2021, over 900 Hawaii residents died from suicide. Suicide is one of the leading causes of preventable death in Hawaii. “Suicide is a multifaceted issue that impacts all of our communities across the State,” said Gina Kaulukukui, co-chair of the Prevent Suicide Hawai‘i Task Force. “Our comprehensive approach to suicide prevention enhances hope, help, and healing to protect our ‘ohana.” Hawaii offers multiple resourc-

Speaker Series Link: embracinghope2022. eventbrite.com

es to address individuals who are in need of help and guidance. Below are the following:

Hawaii Suicide Prevention Website health.hawaii.gov/emsipsb/injury-prevention/suicide-prevention/ Suicide is a significant public health problem in Hawaii. The website offers resources, events, trainings, task force, data and contact information to provide prevention education to the public.

Hawaii CARES 1-800-753-6879, hicares.hawaii.gov This 24/7 free and confidential hotline support people in mental health or substance use-related distress. The call center staff are locally trained and qualified to provide supportive counseling and screening for urgent and emergency mental health and substance use needs. They also do referrals to behavioral health resources.

Vibrant Emotional Health and the American Foundation for Suicide Prevention bethe1to.com, nspw.afsp.org For more information and resources about taking action against suicide, visit the Vibrant Emotional Health website to learn more about the #BeThe1To campaign. Moreover, the American Foundation for Suicide Prevention is also hosting multiple events during National Suicide Prevention Week.

Oahu Sept. 27 – Suicide Prevention Foundations Course Link: eventbrite.com/e/cohenclinic-cfs-presents-suicide-prevention-foundation-with-mha-of-hawaii-tickets-404886124297

Hawaii Poison Control Center 1-800-222-1222, hipoisoncenter.org The control center provides help for poisoning emergencies.

Hawaii is hosting multiple 2022 Hawaii Suicide Prevent Month events. See the following schedules:

State Executive Office on Aging Offers Free Preparation Guidance for Medicare Open Enrollment


he Medicare open enrollment will be starting soon and the Hawaii Executive Office on Aging and the Hawaii State Health Insurance Assistance Program (SHIP) are hosting several events to offer guidance to those turning 65 or those enrolled in Medicare to learn and choose the best Medicare plan to fit their healthcare needs. The Project Grad 65 presentation informs people turning 65 about Social Security retirement benefits and Medicare basics to guide them with the enrollment period in Medicare. The open enrollment period gives beneficiaries the opportunity to join, switch or drop a Medicare plan with coverage beginning on January 1, 2023. The Medicare Annual Open Enrollment period begins on Oct. 15 and ends on Dec. 7. Hawaii SHIP will be available for virtual, phone and in-person sessions to assist kupuna. The following are the program’s resources and schedule:

Phone and Zoom consultations statewide 808-586-7299, 1-888-875-9229, hawaiiship.org A Medicare counselor will contact those who request an appointment within two to five business days. In-person consultations on Oahu One-hour counseling – Appointments are scheduled on a first- come, first-served basis. To make an appointment, call 808-586-7299 or 1-888-875-9229 and visit hawaiiship.org. Oct. 21 and 28, Nov. 10 and 18, 10am-2pm – Consultations will be available at Honpa Hongwanji Hawaii Betsuin located at 1727 Pali Highway, Honolulu Nov. 2 and Dec 1, 10am-2pm – More consultations available at the Pearl City Public Library located at 1138 Waimano Home Road, Pearl City

Statewide Until Oct. 22 – Embracing Hope

Until Nov. 7 – Well-being & Resilience for Health Professional Link: eventbrite.com/e/cohenclinic-cfs-adventist-health-castlewell-being-resilience-course-tickets-406407976197

Maui Sept 23, 12-1pm – Suicide Prevention Foundation Course, contact Danielle Bergan, (danielle.bergan@ mentalhealthhawaii.org) and Kristin Mills (kristin.mills@doh.hawaii. gov) Kauai Visit PreventSuicideKauai.org for details and updates on all Kauai activities.




Monkeypox Arrives in Hawaii, Update on COVID-19 and Recommendation for New Bivalent Booster Vaccines By Edwin Quinabo


he latest emerging infectious disease outbreak of global importance is monkeypox. The contagious disease has spread to all continents. As of September 8, there are 56,609 reported cases of monkeypox globally, 21,274 cases in the U.S., according to the CDC. In Hawaii, the State of Hawaii Department of Health (DOH) reports there have been 28 cases as of September 8, with most of them (21) located in Oahu. “While the risk to most Hawaiʻi residents remains low, local transmission of monkeypox is occurring,” said Deputy State Epidemiologist Dr. Nathan Tan. “The growing number of cases in Hawaiʻi underscores the importance of vaccination—if you are eligible, please take this step to protect yourself and our community.” DOH continues to conduct contact tracing and follow-up with all reported cases.

What is Monkeypox?

Monkeypox is caused by the monkeypox virus, the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox are rarely fatal, but rash that typically accompany monkeypox can be painful and people can experience severe outcomes, health experts say. Monkeypox will typically last 2-4 weeks -- at which time the infected person is contagious – and would require usually home recovery with minimum contact. While most who have been infected recover on their own in their homes, some have been hospitalized. Monkeypox has been recognized as an endemic disease in central and west-

ern Africa since 1970. In an average year, a few thousand cases occur in Africa. But cases outside Africa have previously been limited to only a handful of cases, until now. This global (outside of Africa) 2022 outbreak of monkeypox is a first. The first cluster of cases was found in the United Kingdom in May 2022 and linked to an individual who traveled to Nigeria. It spread through Europe initially. On July 23, 2022 the Director-General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus declared the outbreak a public health emergency of international concern (PHEIC).

Symptoms of monkeypox

Symptoms of monkeypox can include any or all of the following: - Fever - Headache - Muscle aches and backache - Swollen lymph nodes - Chills - Respiratory symptoms (e.g. sore throat, nasal congestion, or cough) A rash that can look like pimples or blisters appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or

anus. The rash goes through different stages before healing completely. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

Who should get vaccinated?

At the moment, the CDC does not recommend widespread vaccination against monkeypox. But the monkeypox situation is being monitored and evolving quickly and could be subject to change. DOH says vaccine supplies are currently limited. DOH’s current eligibility taken from their website are as follows: Hawaii residents ages 18 years and older and fall into one of the following categories: • Had close contact in the last 14 days with a person with known or suspected monkeypox infection • Gay, bisexual, and other men who have sex with men (MSM) and transgender individuals who have multiple or anonymous sex partners (e.g., such as through dating apps) • People who are severely immunocompromised (e.g., advanced or poorly controlled HIV infection [CD4 ≤200 cells/mm3, persistent HIV viral load >200 copies/mL, or a recent HIV-related illness], active cancer treatment, high-dose steroids) or have certain skin conditions, such as eczema, and who have a household member or sex partner at high risk for monkeypox • People in certain occupational risk group. People at risk for occupational exposure to orthopoxviruses include research laboratory workers performing diagnostic testing for monkeypox virus and members of health care response teams designated by appropriate public health and antiterror authorities. Nikka Aquino APRN-Rx; Aiea, Hawaii, said if the CDC eventually recommends monkeypox vaccination to the general population, she would schedule

an appointment to get a shot. “Prevention is better than cure. Not only are we protecting ourselves from the possibility of getting infected but also our loved ones and those around us. Prevention is key! It is significant for us to be careful when coming into close contact with those who may have symptoms. If we feel sick, stay home and avoid others for the time being. Proper and frequent hand-hygiene can also play a crucial role in the prevention of monkeypox,” Aquino said. James Pagdilao, Hilo Hawaii, also said he would get the monkeypox vaccination if recommended by the CDC. “I would definitely get vaccinated as a duty to not only myself, but to the rest of the public population.” He said, “monkeypox is to be taken seriously, as contrary to popular belief, it can be spread through other means than the typical contact. Monkeypox, like any other infectious disease, should be treated like any other infectious disease that requires a Quarantine/Isolation period and careful precautions to avoid further spread.” Franciso (last name withheld), 58, Honolulu, said the outbreak of the monkeypox reminds him of when AIDS broke out. “I was living in San Francisco at the time and many of my friends died. I eventually contracted HIV many years later when the HIV-AIDS cocktail drugs came out which have extended the lives of many living with this disease. Right now monkeypox is mostly affecting the gay men population like AIDS used to be. I hope it can be contained before it becomes more widespread. “I know many in the LGBT community are upset that the Biden administration did not take on the monkeypox virus more aggressively in the earlier days. That window of opportunity closed and the virus is already spreading all over,” Francisco said.

How is monkeypox spread? Prevention

Anyone in close personal contact with a person with monkeypox can get it. The virus could spread by direct contact of infectious rash, scab or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex. The virus can also be contracted from materials (like bed sheets or a door knob) contaminated with the virus. Monkeypox is increasingly becoming known as a sexual contact disease. Health experts say while it could be “sexually transmissible” – sex is only one of the ways that monkeypox can be (continue on S5)




(Monkey Pox Arrives....from S4)

spread. Experts emphasize that any close, sustained skin-to-skin contact (even non-sexually) with someone who has monkeypox can spread the virus. Preventative steps include: 1) avoiding close contact with someone infected with monkeypox as well as touching the objects and materials the person has used; 2) Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom; 3) postpone having new casual sex partners and avoid events where you have close bodily contact with others


Because of the similarities between smallpox and monkeypox, antiviral drugs used to treat smallpox is being used to treat monkeypox infections. The U.S. government has two stockpiled vaccines—JYNNEOS and ACAM2000—that can prevent monkeypox in people who are exposed to the virus. The DOH ordered its full allocation of the JYNNEOS vaccine from the federal government. JYNNEOS is FDA-approved for safe and effective monkeypox prevention in adults. JYNNEOS reduces one’s chances of getting monkeypox and may reduce symptoms after becoming infected.

Monkeypox Vaccine Clinics in Hawaii

Oahu resident options: -Waianae Coast Comprehensive Health Center (in Waianae and Kapolei) at 808-427-0442 -Hawaiʻi Health & Harm Reduction Center (in Honolulu) at 808-521-2437 -Kaiser Permanente, Mapunapuna Medical Office (in Honolulu) at 808432-2000 and prompt #1 (for members and non-members) Limited appointments are also available through DOH by calling our monkeypox hotline at 808-586-4462 or requesting an appointment online. Kauai residents can contact Malama Pono Health Services (in Lihue) at 808246-9577 and the Kauai District Health Office by calling 808-241-3495 Maui residents can contact Malama I Ke Ola Health Center (in Wailuku) at 808-871-7772 Hawai’i Island residents can contact Hamakua-Kohala Health (in Honoka’a) at 808-930-2751 For other sites, call DOH’s monkeypox hotline at 808-586-4462 It’s recommended that if you believe you’ve contracted monkeypox, to contact your personal physician. Treatment for monkeypox is available but must be coordinated through DOH and a physician.

COVID-19 UPDATE in Hawaii

The DOH recommends the use of the first bivalent booster vaccines designed specifically to protect against original

COVID-19 and the most common forms of COVID-19 in Hawai‘i, the BA.4 and BA.5 Omicron subvariants. The BA.5 subvariant accounts for an estimated 91% of the COVID-19 cases in Hawai‘i. The BA.4 subvariant accounts for an additional 4% of the cases in Hawai‘i. “The COVID-19 boosters we have been using do a good job of protecting us against severe illness. The new bivalent boosters are an upgrade because they take into account mutations of the COVID-19 virus to specifically address Omicron subvariants,” said State Health Director Dr. Elizabeth Char, FACEP. The new booster not only protects from severe illness and hospitalization, but also help to minimize even getting infected or getting reinfected. The U.S. Food and Drug Administration issued Emergency Use Authorization for the bivalent COVID-19 boosters late last month. Char said the new booster is available for people 12 years and older. The vaccine is expected to be available for people 12 years and older, which would cover a wider range of the state’s population than the second Covid booster that’s only available for people older than 50 years and immunocompromised. The Hawaii Department of Health has ordered about 38,000 doses of the bivalent Covid-19 booster. The new vaccine is administered by Pfizer and Moderna. The bivalent Covid-19 booster could start arriving this month. The new bivalent vaccines are to be administered as a single booster dose to those who previously completed a primary series of COVID-19 vaccines and those who have had one or two booster doses. Bivalent boosters can only be administered if it has been at least two months since a person’s most recent vaccination. Aquino received her booster shot in September 2021. “I plan to get the fourth shot. The bivalent vaccine targets both the original strains of SARS-CoV2 and the subvariants of Omicron BA.4 and BA.5. “COVID-19 is here to stay. For more than 2 years, people have faced the economic consequences of the pandemic. But is the pandemic ‘over’? I think when we say that the pandemic is over, it does not mean that the virus has been eradicated rather the horrific stage of intense transmission and consequent illness is better controlled. With the constant changes in strains, persons can still get the virus. Some may say that COVID-19 is now similar to just a regular seasonal flu. However, I think that because of the long COVID complication of post-illness, we must all continue to be careful not to spread or catch the virus,” Aquino said. Pagdilao, who says he is moderately immunocompromised, said he got the 4th Bivalent Booster shot. “COVID-19

“While the risk to most Hawaiʻi residents remains low, local transmission of monkeypox is occurring. The growing number of cases in Hawaiʻi underscores the importance of vaccination—if you are eligible, please take this step to protect yourself and our community.”

– Dr. Nathan Tan,

Deputy State of Hawaii Epidemiologist today is still just as serious of an issue than it first started, but due to vaccinations, social distancing, and new studies on the spread of COVID-19, it has become a part of daily life to live with the normalcy of COVID infections. “As opposed to early on in the Pandemic, the majority of the population is vaccinated, resulting in less hospitalizations and less severe infections, so overall COVID is generally like the flu in which we should get updated boosters when available to keep not only ourselves protected, but to protect the rest of our vulnerable populations such as the elderly, those with significant comorbidities, and our keiki,” Pagdilao said. COVID-19 is still very much active and around The DOH Summary Metrics as of Sept. 7, 2022 reports there have been 1,215 news cases of COVID-19 statewide in the last week. Eleven new deaths

were reported, bringing the statewide cumulative death toll to 1,655. Completed vaccination is 77.3% statewide with Honolulu having the highest at 80%. Aquino, who did catch COVID-19 in February 2022, said “I think people should still acknowledge that COVID is still around. Although vaccines and medications are available for us to help prevent the debilitating complications, we can still contract the virus if we are not mindful of it. Each one should be responsible in taking his or her part in controlling the spread of the virus through proper hand hygiene, avoiding extremely crowded areas, and wearing masks or avoiding contact when sick.” Pagdilao who caught COVID-19 in May this year, said “I just hope and pray that we can keep up to date with boosters and obtaining the so-called herd immunity.”




Beyond Borders:


By Avery Go, MD


or almost three years, COVID-19 has had an enormous effect on the world. Lockdowns, social distancing and masks became the new normal. Just when we thought life was starting to return to the normal that we knew, monkeypox appears. Monkeypox is a zoonotic (disease transmitted from animals to humans) viral disease caused by the monkeypox virus that belongs to the Poxviridae family. The origin is unknown, but it was discovered in the 1950s in monkeys kept for research. Infected mammals such as prairie dogs, monkeys, hedgehogs, squirrels and dogs can transmit the virus to humans. Transmission from infected animals happened through bites

and scratches, handling animal products such as skin or fur, or consuming undercooked meat of the infected animals. The first human case was reported in 1970 in the Democratic Republic of Congo and for decades it was a disease considered endemic in Central and West Africa. Human transmission is most commonly caused by direct skin-to-skin contact with a monkeypox lesion or through contact with bodily fluids of an infected person. It can also spread through contact with fomites (fabric, sheets, towels, etc.) that have been in contact with the lesion, and it can also spread through a cough or sneeze from an infectious person. An infected person usually develops symptoms within three weeks of exposure to the virus. The symptoms include flu-like symptoms, exhaus-

tion, swollen lymph nodes, and rash. After the onset of flu-like symptoms, a rash appears between 1-4 days later. The rash may be located on or near the hands, feet, chest, face, and genitalia. The rash will initially look like sores or pimples and transform into blisters. The lesions can be painful and/or itchy and go through several stages including scabs falling off before a fresh layer of skin will appear. The disease appears similar to Varicella, or chickenpox, so it must be differentiated from chickenpox in order to help curb the spread. Infected individuals can be infectious starting from the onset of symptoms until the rash disappears and new skin forms which will typically last between 2-4 weeks. Monkeypox is highly infectious, and we are in the midst of an outbreak. As of the end of August, there are a total of 23 monkeypox cases in Hawaii. Nationally, many of the cases from the outbreak have been among men

who have sex with men. Individuals who have multiple or anonymous sex partners are also at high risk. Vaccines are available to help prevent infection and can be given after exposure. Monkeypox is a self-limiting disease but can last two to four weeks. Treatment is mostly symptomatic but for those who have severe disease, are immunocompromised, or are at high risk for complications, immunoglobulins or antivirals obtained through consultation with the Department of Health and CDC can be given. Measures used for COVID-19 focus on contact and respiratory precautions such as frequent hand washing, wearing masks, and avoiding gatherings where close contact with an infect-

ed person can happen to help limit the spread. If you think you have been exposed or are infected, isolate and call your healthcare provider immediately. Those around or who share a common living space with an infected person should take care not to get in contact with the skin lesions or any material that may have come in contact with the skin lesions. Clean and disinfect frequently touched surfaces and do not share items with others. An infected person should also avoid taking care of pets while sick, as they might spread the virus to the animal who then might spread it to other people. In the midst of another threat, remember to stay vigilant, stay safe and stay healthy!


Inflation Reduction Act’s Health Care Savings


n a press conference, Senator Mazie Hirono shared the new provisions in the Inflation Reduction Act (IRA) of 2022 that will make healthcare more affordable for people across the country. The IRA will empower Medicare to negotiate drug prices for 10 medicines in 2026, which will gradually increase to 60 by 2029. Medicare’s direct negotiation with Pharma is expected to lower the price of drugs. Another IRA provision caps out-of-pocket drug costs for Medicare enrollees at $2,000 per year. Moreover, Sen. Hirono sponsored a provision in IRA to ensure Medicare recipients will receive all necessary vaccinations at no cost. “There are about close to 300,000

seniors in Hawaii who rely on Medicare, and lowering prescription drug costs in Medicare and enabling us to negotiate these costs is something that so many of us who were here, when the Affordable Care Act was first enacted, something that we have been pushing for, for over 10 years. It took that long for us to enact this right to negotiate, something that the VA—which is the largest health care system in our country—has been doing for decades. One thing that is going to make a difference to so many seniors right now is that those seniors under Medicare will be able to get their vaccinations free. One out of three older Americans will be affected by shingles and a lot of them don’t get the vaccine because they had to pay for it—no longer,” said Hirono.




Heart Attack vs Stroke By Zia Khan, MD


or young people, or those who’ve never known someone who’s had a heart attack or stroke, there can be a misperception that heart attack and stroke aren’t related. But they can be, and both are largely preventable if you live a healthy lifestyle. Heart and blood vessel disease (also called heart disease) includes numerous problems, many of which are related to a process called atherosclerosis, a condition that develops when a substance called plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can block the blood flow. This can cause a heart attack or stroke. A heart attack occurs when the blood flow to a part of the heart is blocked by a

blood clot. If this clot cuts off the blood flow completely, the part of the heart muscle supplied by that artery begins to die. Most people survive their first heart attack and return to their normal lives, enjoying many more years of productive activity. But experiencing a heart attack does mean that you need to make some changes. The medications and lifestyle changes that your doctor recommends may vary according to how badly your heart was damaged, and to what degree of heart disease caused the heart attack. An ischemic stroke (the most common type of stroke) occurs when a blood

vessel that feeds the brain gets blocked, usually from a blood clot. When the blood supply to a part of the brain is cut off, some brain cells will begin to die. This can result in the loss of functions controlled by that part of the brain, such as walking or talking. A hemorrhagic stroke occurs when a blood vessel

within the brain bursts. This is most often caused by uncontrolled hypertension (high blood pressure). Some effects of stroke are permanent if too many brain cells die after being starved of oxygen. These cells are never replaced. The good news is that sometimes brain cells don’t die during stroke — instead, the damage is temporary. Over time, as injured cells repair themselves, previously impaired function improves. (In other cases, undamaged brain cells nearby may take over for the areas of the brain that were injured.) Either way, strength may return, speech may get better and memory may improve. This recovery process is

what stroke rehabilitation is all about. When it comes to recognizing a heart attack or stroke and getting help, the faster, the better. That’s because prompt treatment may make the difference between life and death — or the difference between a full recovery and long-term disability. Whether young or old, living a healthy lifestyle is key to preventing your risk of having a heart attack or stroke. The American Heart Association recently updated its lifestyle recommendations to include eight key actions you should follow. It calls those actions Life’s Essential 8. Go to the Association’s web site at https://www.heart.org/en/ healthy-living/healthy-lifestyle to learn how you can live healthier and avoid heart attack and stroke.  DR. ZIA KHAN is a cardiologist and Hawaii Division Board President for the American Heart Association.




Out of the Fire, Into the Frying Pan: Long Covid By Dennis Bautista, MD


or the last three years, COVID-19 has continued to spread among our community, resulting in more than 330,000 cases and 1,641 deaths in the State of Hawaii. According to the Hawaii Department of Health (DOH), there are still an average of about 200+ new cases daily, but the actual number could be much greater because a lot of cases are not reported to the DOH. The combined efforts of the global community has resulted in new policies, infrastructure, and therapeutics that have reduced the severity and deaths from COVID infection. But a new, and mysterious health problem has emerged: Long COVID. It has also been referred to by several other names, including “postCOVID conditions,” “chronic COVID-19”, and “postacute

sequelae of SARS-CoV-2 infection (PASC).”

What is Long COVID? So far there has been no widely accepted definition, but Centers for Disease Control and Prevention, as well as the World Health Organization, describe Long COVID as: “Broad range of symptoms (physical and mental) and symptom clusters that develop during or after COVID-19, continue for more than two months, have an impact on the patient’s life, and are not explained by an alternative diagnosis.” What are the symptoms of Long COVID? As mentioned above, Long COVID patients can suffer from a variety of physical and mental issues. The most common persistent physical symptoms include: Fatigue, Shortness of breath, Chest pain, and Cough. Less common symptoms

include lack of smell, joint pains, nasal congestion, taste abnormalities, poor appetite, dizziness, muscle pain, insomnia, hoarseness, hair loss, and diarrhea. Psychological or cognitive symptoms include new or worsened problems with memory, concentration, anxiety, depression, and post-traumatic symptoms. These symptoms often lead to a patient’s disability, keeping them from going back to work, or even doing their activities of daily living. How long do these symptoms last? The length of time patients continue to suffer from these symptoms greatly vary, from just a couple of weeks to several months. That being said, there seems to be a tendency for patients who are unvaccinated, older, had more severe disease, and had multiple co-morbidities to have a more prolonged course.

What can we do for patients who have Long COVID? Most patients who have mild illness are expected to have resolution of symptoms over a few weeks, even without intervention. Most patients get better. For those who continue to have symptoms, a primary care doctor can help do further investigation, and make sure that they are not dealing with an alternative condition. A primary care doctor can also help alleviate the patient’s symptoms by optimizing a patient’s medical therapy. At times, there may be a need for the patient to go to a specialized center. Here in Hawaii, the Queen’s Medical Center has a “Post COVID Recovery and Care Clinic,” which requires a referral from a PCP.

What can be done to prevent Long COVID? At this time, the most effective prevention is not getting a COVID infection in the first place. This means continuing to take precautions like social distancing and masking when

appropriate.. There is also no over-stressing the importance of COVID vaccinations. There will be a new version of the vaccines (“bivalent booster”) that has been approved by the FDA, and these are aimed at the more current COVID variants. These vaccines have been proven to help prevent COVID infection and hospitalizations. Remember, patients who were hospitalized for COVID were more likely to get long COVID. The work continues Researchers and clinicians continue to study COVID and its long-term effects on patients. In time, there would hopefully be more information on the exact mechanisms behind this condition which may in turn lead to finding more effective treatment. While waiting for all these, we hope the members of the community continue to protect themselves and each other, and to continue to work with their doctors and the local health authorities.





The Impact of COVID on Mental Health and Helpful Coping Techniques By Jay Valdez, Psy.D.

praying, and being part of a church fellowship. 2. Calm your body by doing proper breathing exercises. Breathing exercises tell the brain to relax the body. Proper breathing exercises start with diaphragmatic breathing or stomach breathing.


ince the start of the COVID pandemic, there has been a significant increase in people feeling anxious, depressed, isolated, hopeless, and uncertain about the future. A national survey indicated that anxiety and depression went up 41%. Another survey showed that rates of reported anxiety and depression went up from 1 in 10 people to 4 in 10 during COVID. Additionally, the rate of substance abuse, domestic violence, and suicidality has also increased.

experience panic attacks and shortness of breath, feeling sad, hopeless and helpless. You feel bad about yourself, feeling like you are a failure or let your family down. You are sleeping more or less than the recommended hours. You have lost interest/ motivation in daily activities including those that you enjoyed in the past. You feel numb or not caring about the consequences. You are eating more and/or bingeing on junk foods. You are drinking more alcohol and using more drugs. You are having difficulty Signs That You Need Help concentrating and focusing. You are often worried You feel more irritable or about many things. You are quick to anger and have more afraid of leaving home or go- arguments with your spouse ing out into public or being or loved ones. You are havaround lots of people. You ing mood fluctuations and

thoughts of hurting yourself and/or ending your life. The following coping techniques may help you. 1. Calm your mind by meditating such as playing relaxation music, using a relaxation app, watching relaxation videos on Youtube, listening to a podcast, listening to a book, reading a book, doing a walking meditation, going to church,

Here is a simple technique: find a comfortable sitting position, inhale slowly through your nose for 4-6 seconds, feeling your stomach rise as you feel your chest fill with fresh air. Hold for 5 seconds and slowly exhale through your mouth with your lips pursed (like you are kissing someone), and feel your stomach fall as the air is being released. Another variation is to skip holding your breath for 5 seconds. Practice as often as possible. 3. Make a list of things you

can be grateful for. Our minds have the tendency to remember and hold on to negative events. A gratuity list helps our mind balance our negative thoughts with positive ones. It may also help us look at our lives from a more realistic perspective.

Other healthy coping techniques include journaling, light stretching, light exercise, healthy eating, calling a friend, helping others, watching a funny or inspiring movie, cleaning your house, car, or yard, gardening, and keeping yourself busy and staying on a routine schedule. If you are still struggling, please call your doctor. If you are in crisis, call CARES Hawaii at 808 832-3100, Crisis Text Line at text MHA to 741741, Crisis Helpline at 808 832-3100/800 753-6879 or 911.




Confessions of a Surgeon New Mom By Marel Ver, MD


t took many years of schooling and training to achieve success in my current career as a general surgeon. Additionally, many years of real-life community experience have helped me excel as past President of the Philippine Medical Association (PMAH), as well as attain other leadership positions at my hospital. I married “late” at 38 years old. Then, I embarked on a new challenging journey –having my first child at the age of 40. I was excited and scared, but more scared to be honest. I was very grateful for the blessing, but as a medical provider, had some knowledge about the risks of having a child as an advanced maternal age (AMA) mother-to-be. AMA is defined as having a pregnancy when a woman is over 35 years old. Being pregnant over this age increases the risk of complications like miscarriage, congenital disorders, and overall maternal health risks like high blood pressure and others. Furthermore, as age increases, infertility also rises. Referrals to fertility and reproductive specialists have increased significantly over the last few years. Reproductive medicine is a booming specialty of gynecology. Care involves many appointments, different types of invasive and non-invasive testing, hormonal medications, and even costly reproductive procedures involving patient and partner. Common treatments include intrauterine inseminations (IUI) and in vitro fertilization (IVF). Egg and sperm donation and freezing, and surrogacy may also be discussed. I was one of those who sadly underwent the pain of loss with a miscarriage. I was subsequently referred to a reproductive specialist given the challenge of age and time. I also felt guilt and shame since I thought that I did something wrong. During this leg of my journey, I thought I was alone and one of the few AMA women, but as I learned more and spoke to more people, miscarriages and the use of reproductive medicine is more common than we might think. But because it’s such a personal and traumatic topic of conversation, it is not always talked about freely. My ObGyn (Obstetrics-Gynecology) colleagues state the miscarriage

Dr. Marel Ver with son, Kobe

rate at 35 years old is approximately 15-20%. At 40 years old, it is between 30-40%, and at 45 years old it approaches 50-80%. Miscarriages are most often due to chromosomal genetic abnormalities, which increase with age. Although advances in reproductive technology have resulted in successful pregnancies for many, I did not get pregnant after a significant amount of time and money invested in this emotional rollercoaster. Afterward, I gave myself time to reset and try to get back to my normal busy schedule. To our delightful surprise, we were blessed with a natural pregnancy several months later. My ObGyn colleagues share with me that the percentage of AMA patients can be demographically dependent. There are more AMA pregnancies in countries with higher availability of socioeconomic resources. The decision for family life is also patient-dependent; if a patient embraces the idea of having a large family, then she may start having children early in life well into AMA. In Hawaii, it is also location and race distribution dependent. Culture plays a role in the acceptance of early versus late childbearing. For instance, ObGyn Dr. Lisa Natavio shares that in her previous practice in Wahiawa, with a high population of Filipinos and Polynesian-mix patients, there were less AMA first pregnancy mothers compared to her current Ewa Beach practice, where there is a more variable patient population (ie Hawaii locals, military, new Hawaii residents from mainland, etc). In Ewa Beach, her rate of AMA first moms is about one in five patients compared to her patient population in Wahiawa. AMA patients are often sent to a Maternal Fetal Medicine (MFM) specialist to discuss genetics testing

and risks, complications, and prenatal management. MFM specialists do not just take care of AMA patients, but also those women with higher risks due to medical problems like diabetes, hypertension, and obesity. Dr. Corrie Miller is an MFM specialist in Honolulu and takes care of high-risk pregnancies. Her practice is about 40% AMA. She shares that anecdotally Hawaii has a lower incidence of AMA pregnancies compared to her previous hospital in Connecticut where there is a significant percentage of highly educated white women. Genetic testing may provide a path to decision-making. Some chromosomal abnormalities are incompatible with life. Others can produce a viable baby but possibly with birth defects. MFM specialists help guide patients when difficult decisions may need to be considered. The ObGyn guidelines recommend referral to a specialist after three miscarriages. Many ObGyns start referring at two miscarriages especially since emotions, time, and age are factors. I was under the care of MFM and

ObGyn colleagues who provided excellent personalized guidance and management during my pregnancy journey. Fortunately, I am healthy without baseline medical issues. My colleagues share that in AMA, the amount of prenatal visits is not necessarily increased but does so depending on risks and complications found. They also share that prenatal counseling is not significantly different in younger and older pregnant patients. However, the majority of older patients already have some idea of the risks and expectations of pregnancy. Therefore, maintaining a healthy pre-pregnancy lifestyle is even more important. My genetics testing was negative, but I was monitored closely for placenta previa (placenta blocking the delivery canal). I tried to be as healthy as I could during my pregnancy within the limits of my busy life as a working surgeon. I am very grateful to my husband, professional colleagues, and family who really stepped up to be there for me. I safely delivered my beautiful son on November 10, 2021, via cesar(continue on S12)




(Confessions....from S11)

ean section. Being at the top of my game in my medical field is a stark difference from my life as a rookie new mom, where I often feel lost and sometimes helpless. I didn’t grow up taking care of babies or kids, therefore taking care of my own newborn was a brand new “skill set” I had to learn. Despite advice from many seasoned moms, articles, books, and phone apps, nothing gets you ready for the real thing until the real deal. Being the senior and the leader in my office, I felt somewhat embarrassed asking my younger counterparts for mom advice and hacks. Personally, all my AMA first baby colleagues have since shared that they felt this very same way. At the end of the day, I finally gave in and stubbornly accepted the help that was offered, especially because I really need it for my own health and sanity. I did not train in a generation where motherhood was graciously welcomed in medicine, especially within the surgical field. Therefore, the amount of joy and support for me from my colleagues was refreshing. With more women in medicine and law, leadership positions, and traditionally male-dominated fields, motherhood for the working professional is

slowly gaining wider acceptance and is more celebrated, compared to the past. There are ongoing movements for gender equality in many fields in this country and others. The ‘work-life balance’ is an ongoing challenge. I had to cut down drastically on my workload pre and post-pregnancy. I had to make physical adjustments to safely work in the operating room. I honestly felt guilty about not being able to service my patients or delegating their care to another provider. Many of my patients have been under my care for years. Again, to my surprise, my patients celebrated my pregnancy with me, and were happy that I was actually “taking time for me”,” because I’ve done so much for them.” Perhaps it’s just my luck having such nice patients or the fact that in Hawaii, the concept of family is so highly regarded. As I am back at work again, ramping up to almost pre-pregnancy productivity, I am forced to adjust my schedule and be more efficient, as it’s not just about me anymore. My workdays start later and end earlier so I can pick up my baby son from childcare. Of note, we were lucky to get into daycare, as it was news to us

that there are waiting lists for daycares and schools. It is not easy to find vetted caregivers. It is not easy to find an old-school yaya in the United States. I do not live in a multigenerational home. The concept of my husband or I staying home was considered, but really not feasible in practice given the existing shortage of specialists in both of our fields. Moreover, we help to financially support our parents through our work. I’m still struggling with the idea that work should stay at work. While at home, my energies are to be mom and wife. I’m working on being less stubborn to improve my partnership with my husband as new parents which can be difficult. My husband is probably experiencing similar feelings being an older new dad. Instead of reading about new surgery robots, hernia meshes, and the latest operative techniques, I am now researching strollers, child-proofing devices, and school tuitions. The concept of “mom brain” is real. The tired mom is a whole new different type of tired. I try not to think about the expectant challenges of being that older parent when my child graduates high school and transitions into adulthood. I try not to compare myself to my younger counterparts who seem to physically and mentally bounce back so quickly. I am very grateful to my parents, who are also deemed ‘older’ Lola and Lolo, for helping to care for their first apo given their physical limits. My reality is now the challenge of taking care of my new baby in addition to taking care of our aging parents. For new mom care, mental health screening and monitoring for postpartum blues and depression are very important. The CDC reports about 1 in 8 moms experiences postpartum depression. Interestingly they also report that 1 in 10 new fathers report depressive symptoms. My ObGyn colleagues share that their screening does not differ between young and older patients. However, they do acknowledge that older patients may have a different set of stressors and challenges as compared to younger ones. Despite my candidly honest thinking and perspectives about motherhood, when my son smiles back at me with a face that mirrors mine, it is all worth it. My life has indeed changed. So, this is what parenthood is. The rites of passage and the joy of a little person made from both of you

is a gift, but only a woman can bring life into the world. Like my dedication to being the best surgeon leader I can be, I’m going to be the best mom I can possibly be. I am fortunate to have the personal support of various friends and colleagues to help me do so. But even more importantly, I have the unwavering support and love of my own parents to guide me in this journey. I was always encouraged by my parents to further my career path, with a focus on long-term financial stability. Therefore, starting a family early was not a priority for me. It is not uncommon now that women start family life late when their careers, relationships, and finances are more stable. There are also older women who are still single or those in repeat marriages or relationships. This is in contrast to the general Filipino culture that pushes you to settle with a good job and have a family early. As a mentor to a handful of young Filipinos, this pressure is very real. I have students who struggle with the notion of supporting their families as soon as possible versus following their dreams. Perhaps this sentiment contributes to the scarcity of Filipinos with advanced academic degrees and a decreased presence in higher leadership and executive positions. This article is a personal one to me and may strike a chord with many. I do wholeheartedly believe that we are all born with potential, in a life that is a series of choices. I chose to push towards my potential which delayed motherhood and accepted the risks and unmeasurable joy that comes with it. Until society completely acknowledges, accepts, and adjusts to the journey of motherhood, professional women will often find themselves at a crossroads. Lastly, if you are a young woman who is considering a longer career path, or you are a parent with a daughter who wants to go further, please know that it’s okay. The “biological clock” does exist, but “there is no perfect time to get pregnant” is often said in late path individuals. Know that you are not alone. Know that all of your dreams, even of motherhood, can be possible. And it’s all worth it. I would like to thank and acknowledge my PMAH colleagues, especially Lisa Natavio, MD (ObGyn) and Corrie Miller, DO (MFM) who contributed their expertise to this article. MAREL VER, MD is a general surgeon in West Oahu and recent past president of PMAH.





Teeth Sensitivity By Michael Dang, DDS


oes taking a sip of hot coffee make you wince in pain, or eating ice cream give you a painful chill? You’re not alone. The Academy of General Dentistry says 40 million adults in the United States experience tooth sensitivity. These are a few common causes for tooth sensitivity. • Brushing Too Aggressively Brushing too hard may wear down the protective layers of enamel and root cementum and expose microscopic tubules. These tubules lead to the dental nerve and can cause a shock-

la. Some people can form a hypersensitivity to the whitening chemicals over a period of time.

ing pain. Brushing too hard can also cause the gum to recede, that will lead to pain and sensitivity. • Acidic Diet Citric acids from oranges, lemons, limes, grapefruits, kiwis break down the enamel as well. I tell my patients not to add slices of fruits to their water. While drinking water often is a good thing, having citric acids constantly on your teeth is not because it damages the teeth and causes sensitivity.

by plaque and tartar buildup on your teeth, which can make your gums recede.

• Recurrent Decay Over a period of time fillings can wear down and break around the margins. These tiny crevices trap bacteria which causes acid buildup and enamel breakdown.

• Hard Impact The habit of eating hard candy, ice, grinding your teeth or getting hit in the • Whitening Toothpaste Many toothpaste manu- mouth can chip or crack facturers add tooth whiten- teeth. A small crack in the • Gum Disease Gum disease is caused ing chemicals to their formu- tooth may not be problem-

atic at first but if left unchecked can be very painful. If you’re having tooth sensitivity and wonder what this means to your oral health, give our dental office a call at (808) 596-2568. Most of the time the problem can be resolved from a simple change in behavior, or something as simple as changing your toothpaste. In the case of recurrent decay or a crack tooth a new filling can fix the problem, but it should be taken care of early before the problem worsens. We offer a wide range of services and would be happy to help you deal with your tooth sensitivity or any other oral health concern. I will do my utmost to make your visit a pleasant and comfortable experience.


Protect Your Child’s Eyes and Vision! By Janet Kelley


ith summer ending and a new school year beginning, comes an increase in computer and screen usage, as well as new germ exposures and transmissible variants in our classrooms. Both of which can have serious consequences on our children’s eyes and vision. The rise of digital learning has marked an increase of children experiencing dry eye and eye strain due to prolonged screen time, while full capacity classrooms can become hotspots for colds, viruses, and germs that may cause eye injuries or infections. In support of raising awareness to these issues, The American Academy of Ophthalmology has named August “Children’s Eye Health & Safety Month.” Though many schools are returning to in-person teaching after the nation mandated COVID-19 lockdowns, there are still risks for nearsightedness along with other vision concerns to look out for. Even with non-digital learning tools such as books or other things, it is estimated that roughly 80% of classroom learning is visual. That means

there is still a crucial need to monitor and maintain our children’s eye health. Within the classroom, this can be done by resting their eyes, intentionally blinking, and looking at things further away to prevent discomfort. It is particularly important for children to spend at least a couple hours a day in natural light and have some time away from digital screens in order to protect their eyes. Some studies suggest that spending time outdoors may slow the onset and progression of nearsightedness. The general consensus within the scientific community is that spending time outdoors balances out close-up work and helps maintain strong and healthy eyes in children. The World Health Organization recommends that children under 5 spend one hour or less per day on digital devices, and children under one year old spend no time on digital devices. The Children’s Eye Foundation recommends daily outdoor play, no screen time for those under age 2, a maximum of one to two hours per day for kids ages 2 to 5 and guid-

• •

ed screen time with frequent breaks for kids over 5. Parents can help protect and preserve their children’s eye health and vision by managing their children’s screen time to support educational use while limiting cartoons and video games. Parents can also encourage more outdoor activities by creating a schedule, setting limits on screen time, and planning ahead for outdoor activities. Other recommendations to protect and preserve your children’s eye health are: • Encourage 20-second breaks from closeup work every 20 minutes • Set a timer to remind kids to take those breaks • Keep digital media 18 to 24 inches away from the face • Introduce nutritious and balanced meals and snacks

full of vitamins A, C, and E Make sure they are getting a full and well rested sleep Protect their eyes outside with proper eyewear

Dr. Steven Rhee of Hawaiian Eye Center shares, “An increase in screen-time and decreased time spent outdoors may harm children’s vision and can put them at higher risk of developing myopia, or nearsightedness. This condition can sometimes lead to even more serious eye conditions in their adulthood.” “Increased screen-time and a lack of natural light and time spent outdoors can be harmful to our children’s vision and eye health. These circumstances can put our keiki at a higher risk of developing myopia, or nearsightedness. My biggest concern is that these kinds of conditions can sometimes follow them into adulthood and worsen,” he explained. While doctors and scientists are still learning exactly how myopia develops and progresses, we do know that it can occur when the eye’s focusing power is too strong, causing light rays to focus in front of

the retina instead of on top of it, creating a blurry image in the field of vision. This can make it extremely difficult for children to learn and excel in school and may cause eye pain or headaches. Although nearsightedness can be corrected by glasses or contact lenses, it can still lead to several eye problems later on such as retinal detachment, glaucoma and macular degeneration. The best way to try and stop this from happening to your children’s eyes is to take the proper preventative measures and ongoing eyecare as their eyes and vision continue to develop. “I know there is this stereotype of children today having a short attention span or difficulty concentrating, but I think we forget that there is also a number of new factors at play that may be contributing to this.” Dr. Rhee closes. “It may be a sign that your child is having vision problems and needs you to help them get the right support. We should be reminding them to take breaks, spend time outside, properly lubricate their eyes by blinking regularly.”




Thyroid Health & Hormones By Anna Melissa Lo, MD


s an endocrinologist, I often get asked by non-medical folks what kind of diseases I see in my practice. Endocrinology is a field in medicine that deals with the diagnosis and treatment of hormonal disorders, which can cause a myriad of problems and symptoms, and therefore negatively impact one’s overall health. These hormonal imbalances require careful and meticulous workup so that we can address the problem accordingly and restore the body’s homeostatic functioning. The thyroid gland is a butterfly-shaped organ normally situated in the lower portion of the anterior neck which secretes thyroid hormones. Thyroid hormones travel through the blood stream and affect different tissues in the body. Thyroid hormones play a vital role in maintaining the body’s metabolic rate. The

thyroid gland gets its signal from the brain, particularly from the master hormonal gland called the pituitary gland, and from another higher center in the brain, called the hypothalamus. The hypothalamus-pituitary-thyroid axis works as a cohesive unit to ensure that a normal range of thyroid hormones is secreted and maintained. Problems can arise when any part of this axis is affected. There are several conditions that can cause dysregulation of thyroid hormone secretion. Excess production of thyroid hormones, “hyperthyroidism,” can speed up the body’s metabolism causing symptoms like unintentional weight loss, palpitations, increased nervousness and anxiety, tremors, difficulty of breathing, sleeping disturbances, irregular menstruation, and eye problems.

On the opposite end, some patients end up having less than normal production of thyroid hormones, “hypothyroidism,” which slows down metabolism causing significant weight gain, profound weakness and fatigue, forgetfulness, dry hair and skin, and cold intolerance. Some patients may develop an enlargement of their thyroid gland or “goiter” due to these hormonal disturbances. There are a variety of entities that can cause either hyper- or hypothyroidism in patients.

Autoimmune conditions such as “Graves’ disease” and “Hashimoto’s thyroiditis” are immune-mediated processes that lead to hyperthyroidism and hypothyroidism, respectively. Nutrition also plays a role as in the case of iodine deficiency. Iodine is vital and a key factor in thyroid hormone production. Its scarcity in diet amongst certain countries contributes to a global health problem, with millions of people suffering from hypothyroidism worldwide. As mentioned, hyper- and hypothyroidism affect the production of thyroid hormones. Apart from these, some patients develop distinct lesions or lumps in the thyroid itself referred to as “thyroid nodules.” Most of these thyroid nodules are harmless, but some can increase thyroid hormone production or even turn out to be cancerous. Therefore,

clinically significant bumps in the neck should be thoroughly evaluated. Thyroid disorders are quite common and affect an estimated 20 million Americans in the United States, according to the American Thyroid Association. Women are five to eight times more commonly affected than men. Undiagnosed thyroid disease can cause not only significant symptoms, but also long-term health complications, such as cardiovascular disease, impaired bone health, and even mental issues. If you feel you are having any issues with your thyroid, ask your primary care physician about it, and if necessary, seek a hormone specialist. Thyroid diseases are common and can be distressing. However, most of the disease entities are manageable if proper care and actions are taken in a timely fashion.


UH Reveals Vaccine Hesitancy Factors In Recent Study


he University of Hawaii at Manoa (UHM) and Waianae Coast Comprehensive Health Center (WCCHC) partnered in a research paper to learn more about vaccine hesitancy factors in Hawaii. Published on August 31 in MDPI’s journal titled Vaccines, the paper is titled “Dynamics of Trust and Consumption of COVID-19 Information Implicate a Mechanism for COVID-19 Vaccine and Booster Uptake.” UH researches surveyed almost 1,6000 Hawaii adults enrolled in COVID-19 testing program. Participants completed standardized surveys from January to February 2021. They answered questions regarding

demographics, vaccination status and trust in sources of COVID-19 information during the COVID-19 delta variant wave. Then during the omicron variant wave, 50.3% of those respondents complete ed a follow-up survey from January to February 2022. Results of the study show that participants vaccinated within two months of eligibility tended to have more years of schooling and greater trust in and consumption of official sources of COVID-19 information, compared to those who waited three to six months or more to get vaccinated post-eligibility. Seventy percent of those vaccinated within two months of eligibility took

the booster shot, compared to only 30.5% of those who waited three to six months. The latter group also expressed that they gained trust and consumption of official information after four months. “This study shows that social factors, including education and individual-level degree of trust in sources of COVID-19 information, played a large part in whether someone decided to get a booster shot,” said Ruben Juarez, one of the authors of the study and an economics professor at UHM and HMSA Endowed Professor of Health Economics at UHM’s Economic Research Organization. Fellow author and associate professor at UH’s

John A. Burns School of Medicine (JABSOM) Alika Maunakea said: “Results from our study reinforces the need to nurture trust and promote health literacy in our community, which our model predicts will improve vaccine uptake, including boosters.” Co-author May Okihiro, JABSOM associate professor and WCCHC pediatrician, says: “This date provides critical information for the Department of Health and our community of health

centers to act on the development of effective strategies that include vaccination to help us emerge out of this pandemic.” Aside from Juarez, Maunakea and Okihiro, other co-authors include UHERO graduate research assistant Zheng Khang, JABSOM computational biologist Krit Phankitnirundorn and WCCHC community facilitator Blane K. Garcia. To read the full text of the research paper, head to https://www.mdpi. com/2076-393X/10/9/1435. 